Shift work and problem sleepiness

About 20 million Americans (20 to 25 percent of workers) perform shift work.
Most shift workers get less sleep over 24 hours than day workers. Sleep loss is
greatest for night shift workers, those who work early morning shifts, and
female shift workers with children at home. About 60 to 70 percent of shift
workers have difficulty sleeping and/or problem sleepiness.

The human sleep-wake system is designed to prepare the body and mind for
sleep at night and wakefulness during the day. These natural rhythms make it
difficult to sleep during daylight hours and to stay awake during the night
hours, even in people who are well rested. It is possible that the human body
never completely adjusts to nighttime activity and daytime sleep, even in those
who work permanent night shifts.

In addition to the sleep-wake system, environmental
factors can influence sleepiness in shift workers. Because our society is
strongly day-oriented, shift workers who try to sleep during the day are often
interrupted by noise, light, telephones, family members, and other distractions.
In contrast, the nighttime
sleep of day workers is largely protected by social customs that keep noises and
interruptions to a minimum.

Problem sleepiness in shift workers may result in:

increased risk for automobile crashes, especially
while driving home after a night shift;

decreased productivity (night work performance may be
slower and less accurate than day performance); and/or

increased risk of accidents and injuries at work.

What treatments and remedies can help problem
sleepiness?

Sleep-There is no substitute!

Many people simply do not allow enough time for sleep on a regular basis. A
first step may be to evaluate daily activities and sleep-wake patterns to
determine how much sleep is obtained. If you are consistently getting less than
8 hours of sleep per night, more sleep may be needed. A good approach is to
gradually move to an earlier bedtime. For example, if an extra hour of sleep in
needed, try going to bed 15 minutes earlier each night for four nights and then
keep the last bedtime. This method will increase the amount of time in bed
without causing a sudden change in schedule. However, if work or family
schedules do not permit the earlier bedtime, a 30 to 60 minute daily nap may
help.

Medications/drugs

In general, medications do not help problem sleepiness, and some make it
worse. Caffeine can reduce sleepiness and increase alertness, but only
temporarily. It can also cause problem sleepiness to become worse by
interrupting sleep.

While alcohol may shorten the time it takes to fall asleep, it can disrupt
sleep later in the night, and therefore add to the problem sleepiness.

Medications may be prescribed for patients in certain
situations. For example, the short-term use of sleeping pills has been shown to
be helpful in patients diagnosed with acute insomnia. Long-term use of sleep
medication is
recommended only for the treatment of specific sleep disorders.

If you're sleepy—don't drive!

A person who is sleepy and drives is at high risk for an automobile crash.
Planning ahead may help reduce that risk. For example, the following tips may
help when planning a long distance car trip:

Get a good night's sleep before leaving

Avoid driving between midnight and 7 a.m.

Change drivers often to allow for rest periods

Schedule frequent breaks

If you are a shift worker, the following may help:

decreasing the amount of night work;

increasing the total amount of sleep by adding naps
and lengthening the amount of time allotted for sleep;

increasing the intensity of light at work;

having a predictable schedule of night shifts;

eliminating sound and light in the bedroom during
daytime sleep;

using caffeine (only during the first part of the
shift) to promote alertness at night; or

possibly using prescription sleeping pills to help daytime sleep on
occasional basis (check with your doctor).

If you think you are getting enough sleep, but still feel sleepy during the
day, check with your doctor to be sure your sleepiness is not due to a sleep
disorder.

SOURCE: U.S. Department of Health and
Human Services, National Institutes of
Health. Problem Sleepiness.